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Published on: June 29, 2013
Can umbilical artery pulsatility index predict the outcome of fetuses with structural heart disease?
J A Copel1, J C Hobbins, C S Kleinman
1Yale Fetal Cardiovascular Center, Department of Obstetrics and Gynecology, Yale University School of Medicine, New Haven, Connecticut 06510-8063.
Insights
Umbilical artery Doppler pulsatility index (PI) was not a reliable indicator for fetuses with congenital heart disease (CHD). Elevated PI was observed in some cases, but it did not accurately predict disease severity or outcome.
Area of Science:
- Perinatology
- Fetal Medicine
- Cardiology
Background:
- Umbilical artery Doppler waveforms are used to assess fetal well-being.
- Diminished end-diastolic velocities have been suggested in fetuses with congenital heart disease (CHD).
Purpose of the Study:
- To evaluate the utility of umbilical artery Doppler pulsatility index (PI) in fetuses diagnosed with congenital heart disease (CHD).
Main Methods:
- Assessed 11 fetuses with antenatally diagnosed CHD (19-32 weeks gestation).
- Compared umbilical artery pulsatility index (PI) to normal gestational age percentiles.
- Analyzed PI in relation to chromosomal status and lesion fatality.
Main Results:
- Elevated PI (above 90th percentile) was found in 3 out of 11 fetuses with CHD.
- Elevated PI did not reliably differentiate between fatal and non-fatal cardiac lesions.
- Five of eight fetuses with fatal anomalies had normal PI values.
Conclusions:
- Umbilical artery PI elevation in a subgroup of fetuses with CHD was not clinically useful for predicting outcomes.
- Further research may be needed to identify more accurate Doppler markers for fetal CHD assessment.
Abstract:
Umbilical artery Doppler waveforms have been suggested to demonstrate diminished end-diastolic velocities in anomalous fetuses. We evaluated 11 fetuses with antenatally diagnosed congenital heart disease (CHD) and compared them to a normal population. Fetuses with CHD were studied once each and ranged in age from 19 to 32 weeks gestation. Eight had normal chromosomes, and three were aneuploid. The pulsatility index (PI) was elevated (above the 90th percentile for gestational age) in 3/11 CHD fetuses (P = NS). Elevated PI did not discriminate well between those with fatal and nonfatal lesions. Although all three fetuses with elevated PI had fatal disease, five of eight fetuses with fatal anomalies had normal PI values. We conclude that, while umbilical artery PI values were elevated in a subgroup of affected fetuses, this was not clinically helpful.
